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Medicine and Social Justice will have periodic postings of my comments on issues related to, well, Medicine, and Social Justice, and Medicine and Social Justice. It will also look at Health, Workforce, health systems, and some national and global priorities

Wednesday, October 26, 2011

Fluoridation: Dental health for all

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Fluoridation of the water supply is one of the great public health benefits of the 20th century. It is also one of the persistently more controversial. Ideological opposition (to “the government” doing anything) has mixed with paranoia (they are poisoning us) to create a pretty sustained grass-roots movement, one that has blocked this effort in many places in the country. Now, according to Lizette Alvarez’ article in the NY Times “Looking to save money, more places decide to stop fluoridating the water” (October 14, 2011), saving money has been added to these arguments. The threat is that communities which have had the benefits of fluoridated water will lose them. This is apparently the what is happening in Pinellas County, Florida (the Clearwater/St. Petersburg area), as well as in Fairbanks, Alaska.

The situations in Florida and Alaska may well be different, however. The decision in Fairbanks is apparently tied to the relatively high levels of naturally-occurring fluoride in the water there, which would make fluoridation an unnecessary cost. In Florida, however, the decision seems to be driven by cost as well as the same issues I note above. “I’m in opposition to putting a medical treatment into the public drinking water supply without a vote of the people who drink that water,” said Norm Roche, a newly elected Republican county commissioner who spent 10 years doing policy research for the county Water Department and who led the turnaround effort. “We had a dozen to 15 doctors, dentists, dental hygienists and chemists here who want us to continue this practice but who could not agree themselves on how best to use fluoride.” The article does not further define what Mr. Roche means by “how best to use”, leaving us to imagine if this is an issue of putting it in the water vs another method (fluoridated toothpaste, fluoride treatments at home, fluoride varnishes by health providers) or disagreement as to whether it should be used at all.

In fact, the medical and dental community are pretty much in agreement that fluoride is good for preventing tooth decay, and that dental caries are a major cause of disability both medically and socially. It is hard for a child with a toothache to concentrate at school, not to mention the teasing that can come from having a mouthful of rotting teeth. This latter continues into adulthood; people with bad teeth (or no teeth) are seen as less smart and less competent, and are less likely to be hired in most jobs.

Fluoride works. In my “middle years”, my Chicago dentist had a pretty good idea of my age because he knew when the water in New York City, where I grew up, was first fluoridated. My “6-year molars” were covered with filled cavities (necessitating, all those years later, a lot of restoration work by him), while my “12-year molars”, which erupted after fluoridation, were almost cavity-free. I sure remember getting all those cavities filled, before dentists had high-speed drills or used anesthesia for such a simple, common procedure. My childhood self would certainly advocate for fluoride to prevent that discomfort!

There are, indeed, side effects to high levels of fluoride, whether naturally occurring or otherwise. The main sign of “fluorosis” is “marble teeth disease”, with “grotesque” brown staining of the teeth. It was an investigation into this condition in Colorado Springs in 1909 that led to the discovery both that the cause was high fluoride levels in the water, and that these teeth had virtually no decay (“The Story of Fluoride”, from the National Institutes of Dental and Craniofacial Research). This led to work that identified a level of fluoride that could be added to drinking water that was sufficient to prevent decay but too low to produce this condition.

After spending most of my life in New York and Chicago, one of the most dramatic things to catch my attention early in my stay in San Antonio, Texas, were the young children with stainless steel teeth, whose mouths distressingly reminded me of “Jaws”, the James Bond villain (albeit without the points!). I soon learned two things: 1) the stainless steel teeth were the result of having a great pediatric dental program at our dental school which could fix the mouths of children whose “baby teeth” had all rotted out, allowing them to be both pain-free and able to eat, and 2) the water in San Antonio was not fluoridated, which was a major cause (in combination with other behaviors, such as use of sugared drinks in baby bottles, feeding sugared soft-drinks to young children beyond the bottle years,and “bottle propping” which leaves the milk – and milk sugar – in the baby’s mouth) of the decay the led to the need for such repair. While only a small percentage of children in San Antonio had such stainless steel teeth, a very large percentage had significant and disabling tooth decay.

I also discovered that efforts to pass fluoridation had been defeated in San Antonio on at least two occasions in the past few decades. The opposition was largely from right-wing, John Birch Society, anti-government groups, but also included those who were from the other end of the political spectrum but believed in “natural” health, and thus opposed addition of fluoride. In 2002, an initiative spearheaded by the Mayor of San Antonio, finally led to passage of fluoridation for that city. During this campaign, virtually all the major politicians, all the dentists, physicians, and public health people, and most of the foundations and money were for the initiative. Nonetheless, it passed by only 52% of the vote. The good news here, I guess, is that it is an example of the power of regular people, not very well funded, to resist change being imposed on them. Unfortunately, it was contrary to their health interests.

As I note, the opposition was not solely from the right. During my time in San Antonio, I frequently attended open meetings of a group of progressives in a local Mexican restaurant. Primarily mainstream liberal Democrats, and including the late San Antonio New Deal mayor and newspaper columnist, Maury Maverick, the group was diverse, including socialists and “Greens” and even libertarians, whose interests in lack of government restrictions and privacy invasions gave them common cause. These last two groups, the Greens and libertarians, were opposed to fluoridation. The national Green presidential candidate, Ralph Nader, on a stop in San Antonio, even came out in opposition to the initiative. As a health care provider, I did my best to argue for the benefits of fluoridation, but was unable to win them over.

One argument made they made (at least the libertarians) was that “fluoride might be beneficial, but the government should not put it in our water supply”. Parents could use fluoridated toothpaste or fluoride rinses on their children’s teeth, or bring them to the dentist for fluoride varnish. Well, they could, but often they didn’t, and it was the children who would suffer the caries and their long-term consequences. Indeed in the ‘90s a new syndrome, dubbed “yuppie baby carie syndrome” was identified in children of well-off parents who made their infant formula with bottled water. (The causes of caries from bottle propping and unfluoridated water are well-described in the Wikipedia entry on “Early Childhood Caries”.) Of course, the spread of bottled water to a much wider socioeconomic group makes this even a bigger potential problem. Indeed, some water from natural springs contains minerals, sometimes including fluoride, while the bigger mass-products products from Coke – Dasani – and Pepsi – Aquafina – are municipal tap water that has been “purified” and thus do not.(This does not even begin to touch on all the environmental costs of bottled tap water, from plastic bottles to transporting tap water from one part of the country to another, but that’s another story.)

San Antonio, and more recently San Diego, are victories for fluoridation, while many cities, such as Wichita, remain unfluoridated, and others, such as Pinellas County and Fairbanks are going the other way. If Fairbanks has sufficient natural fluoride, then supplementation is an unnecessary cost. For those communities without adequate natural fluoride, it is a big mistake.

9 comments:

Actually, fluoridation has no basis in science. Fluoride is neither a nutrient nor essential for healthy teeth, that makes fluoride a drug. Like all drugs, fluoride has side effects and shouldn't be dispensed in the water supply and dosed based on thirst - instead of weight, age, health or need.

Fluoridation began with the belief that ingested fluoride incorporated in young children's developing teeth to make them resist decay. Science has proven that theory wrong. Fluoride only hardens teeth topically but swallowing fluoride can lead to a whole host of health problems. See http://www.FluorideAction.Net/health

More than 3,825 professionals (including 328 dentists) urge that fluoridation be stopped citing scientific evidence that ingesting fluoride is ineffective at reducing tooth decay and has serious health risks. See statement: http://www.fluoridealert.org/professionals-statement.aspx

Eleven US EPA unions representing over 7000 environmental and public health professionals are calling for a moratorium on fluoridation.

The CDC reports that 225 less communities adjusted for fluoride between 2006 and 2008. About 100 US and Canadian communities rejected fluoridation since 2008.

There are many large scientific studies to show that drinking fluoridated water has no positive effect on cavity reduction and to show that it causes cancer, thyroid damage, broken hips, lowered IQ and other health problems. The best source for scientific information on fluoridation can be found here: (www.fluoridealert.org).

If fluoride were "proven," there should be evidence of its success in Kentucky, which has been 100% fluoridated for over 40 years. However, government records show that Kentucky leads the nation in the number of dental cavities in children, and in the number of completely toothless adults. The same ineffectiveness is evident in many states and cities.

Most of Europe (16 countries) has considered and has rejected fluoridation and is 98% fluoride free. The World Health Organization reports that these countries have a better tooth decay rate than any fluoridated country.

Even if fluoride was helpful to teeth, trying to distribute any drug in drinking water is the most expensive and wasteful way to do it.

People drink only 1/2% (one-half percent) of the water they use. The remaining 99 ½ % of the toxic fluoride chemical is dumped directly into our environment through the sewer system. I am a Civil Engineer, so I am very familiar with community water systems.

For example, for every $1000 of fluoride chemical added to water, $995 would be directly wasted down the drain in toilets, showers, dishwashers, etc., $5 would be consumed in water by the people, and less than $0.50 (fifty cents) would be consumed by children, the target group for this misguided practice. Your local water department can confirm all of this.

That would be comparable to buying one gallon of milk, using six-and-one-half drops of it, and pouring the rest of the gallon in the sink. Can you think of a more wasteful government program? Giving away fluoride tablets free to anyone who wants them would be far cheaper and certainly more ethical, because then we would have the freedom to choose.

There are many large scientific studies to show that drinking fluoridated water has no positive effect on cavity reduction and to show that it causes cancer, thyroid damage, broken hips, lowered IQ and other health problems. The best source for scientific information on fluoridation can be found here: (www.fluoridealert.org).

If fluoride were "proven," there should be evidence of its success in Kentucky, which has been 100% fluoridated for over 40 years. However, government records show that Kentucky leads the nation in the number of dental cavities in children, and in the number of completely toothless adults. The same ineffectiveness is evident in many states and cities.

Most of Europe (16 countries) has considered and has rejected fluoridation and is 98% fluoride free. The World Health Organization reports that these countries have a better tooth decay rate than any fluoridated country.Even if fluoride was helpful to teeth, trying to distribute any drug in drinking water is the most expensive and wasteful way to do it.

People drink only 1/2% (one-half percent) of the water they use. The remaining 99 ½ % of the toxic fluoride chemical is dumped directly into our environment through the sewer system. I am a Civil Engineer, so I am very familiar with community water systems.

For example, for every $1000 of fluoride chemical added to water, $995 would be directly wasted down the drain in toilets, showers, dishwashers, etc., $5 would be consumed in water by the people, and less than $0.50 (fifty cents) would be consumed by children, the target group for this misguided practice. Your local water department can confirm all of this.

That would be comparable to buying one gallon of milk, using six-and-one-half drops of it, and pouring the rest of the gallon in the sink. Can you think of a more wasteful government program? Giving away fluoride tablets free to anyone who wants them would be far cheaper and certainly more ethical, because then we would have the freedom to choose.

The self-serving declaration by the US Centers for Disease Control that fluoridation is one of the top ten public health achievements of the twentieth century is unsubstantiated rubbish and does not take into account its shonky source. The statement emanates from a 1999 CDC Morbidity and Mortality Weekly Report, an in-house journal that is not externally peer-reviewed.The report was written by just two members of the Oral Health Division of the CDC, Scott Tomar (a dentist who had not published anything on fluoridation before) and Susan Griffin (an economist) and evidence cited for the safety of fluoridation was a review already six years out of date Also, the evidence cited for effectiveness of fluoridation is easily rejected based on available WHO data. But it is even worse than this. The only CDC employees who make statements on water fluoridation are members of this same Oral Health Division – that is 30 people out of the 14,000 employees at this huge federal agency. Most of these 30 people, like Tomar and Griffin, have little or no training in toxicology or specialized areas of medicine. Their qualifications are largely dental and their mission is to promote fluoridation with a zealotry second only to the American Dental Association (ADA).Sadly, most members of the public, the media and the medical community are blissfully unaware of this and take their words on fluoridation as gospel.The CDC cannot be trusted on either the safety or effectiveness of water fluoridation.

Correct me if I'm wrong, but isn't excessive intake of fluoride bad for a person's health? Yes, it's good for the teeth, but there was never a mention that fluorides should be consumed; only applied. I've also read the previous comments here and I agree with them 100% percent. If indeed fluoride has a healing prowess then shouldn't the number of sick people plummet?